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Capturing productivity data on patient access staff is "critically important" in establishing cost-effective staffing benchmarks, says Mark S. Rodi, MHA, CHAM, associate vice president of revenue management at Geisinger Health System in Danville, PA.
"Successfully staffing a patient access area directly contributes to increased patient satisfaction scores, effective patient flow, and reduction of staff turnover levels," says Rodi.
Productivity is hard to measure in patient access areas, however, says Rodi. The primary reason is that multiple members of the team contribute to the successful financial clearance of the patient encounter. "Often, IT systems capture the last team member involved in the patient account and attribute the completion of the registration solely to this staff member," says Rodi. Data doesn’t always reflect the contributions made by all the other employees in scheduling, pre-registration, financial counseling, and registration.
"Turnover rates tend to be significant in patient access," notes Rodi. "A proven method of reducing staff turnover is the establishment of staffing benchmarks which can be flexed according to demand."
Patient access leaders need productivity data to make effective decisions in scheduling and registration areas on a daily basis, emphasizes Rodi.
"Without this information, managers cannot adequately staff their respective areas," says Rodi. "They cannot forecast patient demand and will not be able to flex staff to other patient access areas." (See related story, p. 101, on must-have metrics for patient access areas.)
Patient access leaders must determine which metrics are the most representative of the job duties staff performs, says Jeff Markins, a financial analyst at Nationwide Children’s Hospital in Columbus, OH. They also must consider varying patient volumes or job duties in the same areas on different shifts.
"Midnight shift in the ED may have significantly less patient volumes than day shift. So the staff may perform electronic insurance verification for scheduled patients during lulls," says Markins.
Poor performers are difficult to identify without productivity data, he adds. This problem could cause a decline in department performance and morale. "Serious issues may not be addressed in a timely manner," says Markins. "This, in turn, could negatively affect the hospital’s bottom line."
Given the multiple functions now performed by a registrar, productivity data is essential to ensuring that key revenue cycle needs are met, according to Frank Danza, senior vice president and chief revenue officer at North Shore — LIJ Health System in Manhasset, NY.
Productivity data ensures that staffing is adequate and that staff members are able to acquire complete demographic information, obtain insurance information, determine patient responsibility, collect copays, and provide financial counseling, says Danza.
If patient access leaders lack this information, he says, "revenue cycle activities can fall to a lower priority in admitting and registration areas that support a large volume of patients or are constrained for space."
Many patient access areas lack technology that allows them to monitor productivity easily, says Joseph Ianelli, associate director of admitting at Massachusetts General Hospital in Boston.
"It does take some investment," Ianelli acknowledges. "But all of this is tied to finance and revenue."
The fastest registrars might be the same ones creating the most duplicate medical record numbers, or they might make the most mistakes resulting in denied claims.
"It’s not just about the productivity, but also accuracy and quality," warns Ianelli. "Productivity is the first piece, but beyond that, are they also accurate?"
Productivity data sometimes reveals that appearances are somewhat deceiving. "Sometimes, the ones running around looking the busiest aren’t necessarily the most productive employees," Ianelli says. Likewise, some staff members appear very unproductive according to the data, but the quality of their work makes up for it. "I always recommend taking a broader view than just the numbers," says Ianelli. "Data has its limitations."
One registrar works more slowly than her colleagues, but hardly ever has a claims denial because her work is so accurate. "I try to look at people really comprehensively," says Ianelli. "You need to consider what you get in terms of reliability and commitment to an organization."
If a registrar isn’t meeting productivity goals because he or she is very detail-oriented, Ianelli tries to find another role for that employee.
"If somebody is a great employee who is contributing to the overall mission but is just not meeting productivity goals, it’s never a good idea to just wash your hands of them," he says.